Cardiac Arrests May Have ‘Domino Effect’ in Hospitals

New research shows that cardiac arrests and intensive care unit transfers might happen in bunches, and for a reason.

In a research letter published Tuesday in JAMA, several doctors at the University of Illinois Chicago examined how “critical illness events” such as cardiac arrest and ICU transfers “disrupt workflow in a hospital ward.”

In what the researchers believe was the first study of its kind, they examined consecutive adult admissions from 2009 to 2013 where “rapid-response teams” were used in 13 different medical-surgical wards in differing geographic areas. The wards had patient-nurse ratios of 4:1 on average, with one charge nurse and approximately 20 beds per ward. Physician staffing teams included one attending physician and two to three resident trainees or a hospitalist per ward.

Out of almost 84,000 admissions, there were 179 cardiac arrests and 4,107 transfers to the ICU. The researchers found that the chances of a cardiac arrest or ICU transfer was greater if an event had occurred somewhere else on the ward during the same six-hour window. The findings suggest that adverse events occurred when resources were diverted from the patient population as a whole to tend to one patient during an emergency. “The association may be explained by the diversion of resources to critically ill patients, which may result in caregivers being less attentive to other ward patients,” the researchers wrote.

“Development of a critical illness event in a patient was associated with a higher risk of cardiac arrest or ICU transfer in other patients on the same ward,” the researchers concluded. “Although the absolute increased risk was small, these events were associated with high morbidity and mortality.”

In a highly cited 2002 study in the New England Journal of Medicine, researchers found that higher staffing levels of registered nurses resulted in fewer adverse events, including cardiac arrest.

“In a large sample of hospitals from a diverse group of states, after controlling for differences in the nursing case mix and the patients’ levels of risk, we found an association between the proportion of total hours of nursing care provided by registered nurses or the number of registered-nurse–hours per day and six outcomes among medical patients,” the researchers from Harvard School of Public Health and Vanderbilt School of Nursing wrote. “These were the length of stay and the rates of urinary tract infections, upper gastrointestinal bleeding, hospital-acquired pneumonia, shock or cardiac arrest, and failure to rescue (the death of a patient with one of five life-threatening complications — pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep venous thrombosis).”

In a recent opinion piece in the Washington Post, Dr. David Silbersweig, a psychiatry professor at Brigham and Women’s Hospital and Harvard, bemoans how teaching hospitals have become under increased scrutiny in the current environment of affordable healthcare. He says this increased scrutiny, from the news media and others, has resulted in a “corporatization” of teaching hospitals; thereby threatening staffing levels. “Endless meetings and initiatives to make processes leaner and to remove waste may be imperative for the responsible, viable running of the teaching hospitals. But the relentless focus on these real concerns increasingly comes up against a point beyond which staffing and funding cuts endanger the academic mission, before endangering patient safety — the point no one wants to reach.”

A professional journalist nearly 30 years, David Heitz started his career at the Quad-City Times in Davenport, Iowa before moving to Los Angeles. He led the Glendale News-Press to best small daily newspaper in the state (CNPA) as managing editor and also worked as executive news editor of the Press-Telegram. He worked briefly as deputy news editor of the Detroit News before returning to the Quad-Cities, where he has worked as a freelance medical writer since 2012 for several national websites. He recently purchased his childhood home and says he truly is “living the dream.”

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